“Drunkorexia” Treatment Strategies for Co-Occurring Eating Disorders and Alcohol Use Disorders Dorie McCubbrey, MSEd, PhD, LPC, CEDS Creator, Eating Disorder Intuitive Therapy (EDIT)™ Owner & Clinical Director, Positive Pathways Eating Disorder Intuitive Therapy 165 Cook Street • Suite 10 EDIT™ Certified Counselors Denver CO 80206 720-606-3242 PositivePathways.com Learning Objectives 1. Review recent research regarding “drunkorexia” and describe the specific DSM-5 behaviors indicative of a co-occurring Eating Disorder (ED) - Alcohol Use Disorder (AUD) 2. Discuss an integrative treatment approach called Eating Disorder Intuitive Therapy (EDIT)™ featuring evidence-based practices 3. Evaluate EDIT™ treatment strategies using case studies of clients in recovery from co-occurring ED-AUD In Memory of Laurence Freedom, LPC, LAC April 9, 1954 - November 13, 2016 About the Presenter: Dr. Dorie McCubbrey • PhD – Biomedical Engineering (University of Michigan) • MSEd – Clinical Counseling (University of Akron) • LPC – Licensed Professional Counselor (#2532) • CEDS – Certified Eating Disorder Specialist (IAEDP) • LAC (expected in 2017) – Licensed Addiction Counselor • Owner & Clinical Director – Positive Pathways, Ltd • Bestselling Author – two books; currently writing third book • Media Features – Denver 7 News, FOX News, Shape Magazine, & many more • Creator, Trainer & Supervisor – Eating Disorder Intuitive Therapy (EDIT)™ What is “Drunkorexia”? Co-Occurring Alcohol Abuse & Eating Disorder Behaviors • 39th Annual Research Society on Alcoholism (June, 2016) • Rinker et. al. – 1200 college students’ drinking behaviors • 80% combined drinking with eating disorder behaviors • equal number of men / women with “drunkorexia” behaviors • ED behaviors included fasting, self-induced vomiting • binge drinkers more likely to engage in ED behaviors • desire to reduce calories and increase alcohol’s effects “Drunkorexics” Are Thinking… If I throw up I won’t gain weight I can’t wait for happy hour – to heck with appetizers, I wanna get buzzed! I’m on the “alcohol diet”– if I get hungry, just do a shot! If I throw up then I can drink more Drunkorexia Quiz 1. I skip one or more meals if I know I’m going out drinking later. 2. When I drink, I always have at least 3 drinks, and usually more. 3. I’m trying to lose weight, or worried about gaining weight. 4. I make myself throw up after eating and/or drinking, to save calories. 5. I like to drink on an empty stomach so I get buzzed more quickly. 6. If alcohol is not available when I want to drink, I feel agitated and upset. 7. I track my calories (i.e., using a fitbit), to stay below a target number. 8. I try to exercise before draining to compensate for the calories in alcohol. 9. I avoid eating while I’m drinking to keep my calories consumed lower. 10. I use laxatives to get rid of food I eat before or during drinking. Scoring: count the number of questions answered YES 0: Body-Accepting Socializer – low risk of eating disorders / alcoholism 1-3: Dieting Drinker – medium risk or eating disorders / alcoholism 4-6: Weight-Obsessed Partier – high risk of eating disorders / alcoholism 7-10: Drunkorexic – you probably have an eating disorder and/or alcoholism DSM-5: Anorexia Nervosa (AN) A. Restriction of energy intake relative to requirements, leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health. Significantly low body weight is defined as a weight that is less than minimally normal or, for children and adolescents, less than minimally expected. B. Intense fear of gaining weight or becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly low weight. C. Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight. DSM-5: Anorexia Nervosa (AN) The ICD-10-CM code depends on subtype: Restricting Type: During the last 3 months, the individual has not engaged in recurrent episodes of binge eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas). This subtype describes presentations in which weight loss is accomplished primarily through dieting, fasting, and/or excessive exercise. Binge-eating/purging type: During the last 3 months, the individual has engaged in recurrent episodes of binge eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas). DSM-5: Anorexia Nervosa (AN) Specify current severity: The minimum level of severity is based, for adults, on current body mass index (BMI) or, for children and adolescents, on BMI percentile. The ranges below are derived from World Health Organization categories for thinness in adults; for children and adolescents, corresponding BMI percentiles should be used. The level of severity may be increased to reflect clinical symptoms, the degree of functional disability, and the need for supervision. Mild: BMI ≥ 17 kg/m2 Moderate: BMI 16-16.99 kg/m2 Severe: BMI 15-15.99 kg/m2 Extreme: BMI < 15 kg/m2 DSM-5: Bulimia Nervosa (BN) A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following: 1. Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than what most individuals would eat in a similar period of time under similar circumstances. 2. A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating). DSM-5: Bulimia Nervosa (BN) B. Recurrent inappropriate compensatory behaviors in order to prevent weigh gain, such as self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting; or excessive exercise. C. The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for 3 months. D. Self-evaluation is unduly influenced by body shape or weight. E. The disturbance does not occur exclusively during episodes of anoxia nervosa. DSM-5: Bulimia Nervosa (BN) Specify current severity: The minimum level of severity is based on the frequency of inappropriate compensatory behaviors. The level of severity may be increased to reflect other symptoms and the degree of functional disability. Mild: An average of 1-3 behaviors per week Moderate: An average of 4-7 behaviors per week Severe: An average of 8-13 behaviors per week Extreme: An average of 14 or more behaviors per week DSM-5: Binge-Eating Disorder (BED) A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following: 1. Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than what most individuals would eat in a similar period of time under similar circumstances. 2. A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating). DSM-5: Binge-Eating Disorder (BED) B. The binge eating episodes are associated with three or more of the following: 1. Eating much more rapidly than normal. 2. Eating until feeling uncomfortably full. 3. Eating large amounts of food when not feeling physically hungry. 4. Eating alone because of feeling embarrassed by how much one is eating. 5. Feeling disgusted with oneself, depressed, or very guilty afterward. DSM-5: Binge-Eating Disorder (BED) C. Marked distress regarding binge eating is present. D. The binge eating occurs, on average, at least once a week for 3 months. E. The binge eating is not associated with the recurrent use of inappropriate compensatory behavior as in bulimia nervosa and does not occur exclusively during the course of bulimia nervosa or anorexia nervosa. DSM-5: Binge-Eating Disorder (BED) Specify current severity: The minimum level of severity is based on the frequency of inappropriate compensatory behaviors. The level of severity may be increased to reflect other symptoms and the degree of functional disability. Mild: 1-3 binge-eating episodes per week Moderate: 4-7 binge-eating episodes per week Severe: 8-13 binge-eating episodes per week Extreme: 14 or more binge-eating episodes per week DSM-5: Alcohol Use Disorder (AUD) A. A problematic pattern of alcohol use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12-month period: 1. Alcohol is often taken in larger amounts or over a longer period than was intended. 2. There is a persistent desire or unsuccessful efforts to cut down or control alcohol use. 3. A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects. 4. Craving, or a strong desire or urge to use alcohol. DSM-5: Alcohol Use Disorder (AUD) 5. Recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school, or home. 6. Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol. 7. Important social, occupational, or recreational activities are given up or reduced because of alcohol use. 8. Recurrent alcohol use in situations in which it is physically hazardous. 9. Alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol. DSM-5: Alcohol Use Disorder (AUD) 10. Tolerance, as defined by either of the following: a. A need for markedly increased amounts of alcohol to achieve intoxication or desired effect. b. A markedly diminished effect with continued use of the same amount of alcohol.